1 The Patient’s Perspective Angela Coulter Picker Institute Europe

2 Three Perspectives on Quality Professional: technical competence, clinical outcomes Professional: technical competence, clinical outcomes Management: cost-effectiveness, risk management, service development Management: cost-effectiveness, risk management, service development Patient: access, responsiveness, communication, symptom relief, quality- of-life Patient: access, responsiveness, communication, symptom relief, quality- of-life

3 Patient-Centred Care Prompt access Prompt access Respect for patients’ preferences Respect for patients’ preferences Co-ordinated care Co-ordinated care Information and education Information and education Physical comfort Physical comfort Emotional support Emotional support Involvement of family and friends Involvement of family and friends Continuity and transition Continuity and transition

4 Methods for Seeking Patients’ Views Observations Observations Interviews Interviews Diaries Diaries Focus groups Focus groups Surveys Surveys Meetings Meetings

5 Uses of Patient Surveys Identify priorities for quality improvement Identify priorities for quality improvement Reduce complaints Reduce complaints Promote patient safety Promote patient safety Monitor health system performance Monitor health system performance

6 Overall, how would you rate the care you received?

7 Reporting Questions A&E care disorganised38% A&E care disorganised38% Reason for delay not explained6% Reason for delay not explained6% Staff gave conflicting information23% Staff gave conflicting information23% Doctors talked as if I wasn’t there30% Doctors talked as if I wasn’t there30% Had to wait too long for pain medicine9% Had to wait too long for pain medicine9% Risks and benefits not discussed 24% Risks and benefits not discussed 24% Not told when to resume activities60% Not told when to resume activities60%

8 Problems With Rating (Satisfaction) Questions Yield positive results, which do not reflect reported experience Yield positive results, which do not reflect reported experience Do not discriminate well between countries, hospitals, units Do not discriminate well between countries, hospitals, units Do not help to identify causes of dissatisfaction or priorities for quality improvement Do not help to identify causes of dissatisfaction or priorities for quality improvement

9 Measure Patients’ Experience, NOT Patient Satisfaction Reporting NOT Rating.

10 Didn’t have enough say about treatment (Picker Inpatient Surveys)

11 Test results not clearly explained (Picker Inpatient Surveys)

12 Not told about side-effects (Picker Inpatient Surveys)

13 Not told about danger signals to watch for (Picker Inpatient Surveys)

14 Most Common Problems Not enough involvement in decisions Not enough involvement in decisions No one to talk to about anxieties and concerns No one to talk to about anxieties and concerns Tests/treatments not clearly explained Tests/treatments not clearly explained Insufficient information for family/friends Insufficient information for family/friends Insufficient information about recovery Insufficient information about recovery

15 Patient Feedback Should Be Used to Stimulate Change

16 Using Patient Surveys to Improve Quality in a Swedish Hospital (1) Observation of admission routine and patient pathways Observation of admission routine and patient pathways Changed procedure Changed procedure Waiting reduced Waiting reduced

17 Using Patient Surveys to Improve Quality in a Swedish Hospital (2) Reorganised into smaller groups Reorganised into smaller groups Staff training in communication Staff training in communication Nurses involved when doctors talked to patients Nurses involved when doctors talked to patients

18 Using Patient Surveys to Improve Quality in a Swedish Hospital (3) Action plan Action plan Specialist nurse Specialist nurse Staff training Staff training Self-medication Self-medication Regular surveys of pain control Regular surveys of pain control

19 Summary Measure experience, not satisfaction Measure experience, not satisfaction Survey results should be published and used Survey results should be published and used Patient feedback should drive quality improvements Patient feedback should drive quality improvements

20 Health Expectations An international Journal of Public Participation in Health Care and Health Policy Patient-centred care and quality improvement Patient-centred care and quality improvement Patients’ participation in treatment decisions Patients’ participation in treatment decisions Eliciting users’ views of health services Eliciting users’ views of health services Public perceptions of health services Public perceptions of health services Citizen involvement in health care policy making Citizen involvement in health care policy making Citizen involvement in priority-setting Citizen involvement in priority-setting Methods for monitoring and evaluating participation Methods for monitoring and evaluating participation Empowerment and consumerism Empowerment and consumerism Editor: Angela Coulter Deputy Editor: Vikki Entwistle Published Quarterly, Paper , Online Papers are invited for publication – for more information and Guidelines for Authors visit